Insurance & Cost for Endometriosis Care
Yes, we work with your insurance. It works differently here, and the difference is in your favor.
The usual arrangement that can often let you down
What "We Take Insurance" Usually Means
When most practices say they take your insurance, they mean they hold a contract with your insurer. That contract gets you in the door, but it does not always decide what happens after.
You have probably heard the stories, or lived one... A procedure is approved. The surgeon is in network. Everything is confirmed in advance. Then a bill arrives weeks later, because the insurer reassessed the claim, reclassified the procedure, or decided the documentation did not support what was authorized. In the end, being "in-network" does not protect you from that outcome. It never did.
How it works here
Provide Your Insurance Information, and We Take It From There
Steven Vasilev, MD, PC is "out-of-network" with all insurance plans, which means we hold no insurer contracts. This means we have no general contract terms to protect and no reason to pass a shortfall back to you. Instead, our team advocates for you as an individual with most PPO plans. While coverage is never guaranteed, what is guaranteed is that you will know where things stand before you undergo surgery. Please note that HMO plans are very restrictive and usually do not offer a path that our team can work with. However, we are happy to look for exceptions on your behalf.
No obligations, zero cost
Share Your Insurance Information
We collect your plan details when you first reach out. Providing them commits you to nothing and costs you nothing. It simply lets us start looking at your specific benefits rather than guessing.
Independent review
Your Case Goes to Our Advocacy Partner
We work with an outside group focused specifically on securing coverage for highly subspecialized care. This is their entire practice, and they review your plan directly rather than working from a script.
The formal pathways
Your Plan Is Reviewed and Coverage Pursued.
Depending on your benefits, multiple formal pathways may apply to your case including but not limited to a Single Case Agreement, a GAP exception, prior authorization, or an appeal. These rarely surface when you call the number on the back of your card, but they are legitimate processes worth pursuing before you rule anything out. Our team does exactly that for you and does it well. But please understand that if an appeal is necessary, it can take some time and is due to processes established by your insurance.
Before you commit
You Find Out Where You Stand
We do not book surgery before our team sees a financial path forward that is acceptable to you. In any case, you will have a clear answer about coverage before you undergo surgery or billable care.
The backup plan
A Fixed Price, Set Before Anything Begins
Reach out to begin your assessment →Should the insurance pathway close despite our team's best efforts, we provide a personalized Good Faith Estimate and walk through it with you. Estimates are determined case by case, depending on your circumstances and complexity. Nothing proceeds until you have seen that number and accepted it. Never after.
The part that matters most
No Surprise Bills. Ever.
We do not balance bill. Your financial responsibility is established before surgery, and it does not change afterward based on what your insurer ultimately pays. If the plan pays less than expected, or reverses a decision after the fact, that does not become a new bill to you. That risk is on us.
Every dollar you are responsible for is disclosed and agreed to before care is rendered. There is no version of this where you wake up from surgery and find out later that the arrangement changed.
Note: hospital facility fees, anesthesia, pathology, and imaging are billed separately by those providers. Hospitals contract with insurers independently of physicians, so whether the facility itself is in-network depends on your specific plan — not on anything we control. When the hospital facility is in-network for you, your copay for our professional services is processed at your in-network rate.
Cost clarity
What Will This Actually Cost Me?
- Surgery is typically performed at a hospital facility that is in-network for your plan.
- If an insurance path forward is secured by our team→ your copay is at your in-network rate, and your total is generally limited to your in-network deductible, copay, and coinsurance.
- If there is no insurance path forward → the fixed Good Faith Estimate for professional services applies instead, agreed to before surgery — a cash-pay amount which depends on your personal circumstances, not generic.
- An in-network surgeon ≠ a smaller bill — your deductible and coinsurance matter more than directory status.
- A second, repeat or corrective surgery is the most expensive outcome of all.
If your insurer already told you no
Your Insurer's First Answer Is Rarely the Final One
Insurance call centers work from standardized benefit scripts written around routine specialty care. The representative you reach is reading a general summary of your plan, not reviewing your personal medical situation. Those scripts are not built to distinguish a standard surgical and perioperative care plan from quaternary-level care that is not widely available inside most networks.
They also tend to answer a narrower question than the one you asked. "Is this provider in network?" has a quick answer. "Does my plan cover care that no in-network provider can deliver?" does not, and it is the question that actually matters in complex cases.
So the first answer you get may not reflect how your benefits are ultimately applied. That phone call is a starting point, not a verdict, and it is not the process our advocacy partner uses. Their review looks at your actual plan documents, your clinical situation, and the formal pathways described above.
If you have already been told no, bring us that answer anyway. It costs you nothing to have someone look at it properly before you rule anything out.
Situations that work differently
Not Every Plan Follows the Same Path
Most patients move through the process described above. A few coverage types do not, either because the pathways are unavailable or because the plan is structured differently from the start. If one of these applies to you, we will tell you on the first call rather than after weeks of review.
Medicare and Medi-Cal
The process described above does not apply to Traditional Medicare or Medi-Cal. These programs do not enter Single Case Agreements or GAP exceptions with out-of-network physicians, and there is no appeal or negotiation pathway that changes that. Our advocacy partner cannot alter the outcome, and we will not put you through a process that has no chance of succeeding.
Some Medicare Advantage plans are different. These are commercial plans administered by private insurers, and many include out-of-network benefits worth reviewing. If you have one, we will look at it. Otherwise we can discuss cash and financing as a path forward.
If insurance is not an option
If out-of-network benefits are unavailable, or an agreement cannot be secured after appeal, care can proceed on a pre-arranged cash-pay basis. In that case:
- You receive a personalized Good Faith Estimate
- Professional fees are paid in full in advance
- We do not balance bill afterward. The number you agreed to is the number.
- Third-party medical financing may be available
We are deliberately cautious about steering anyone toward a large upfront cash payment. Insurance-supported pathways usually leave patients paying less, which is why we exhaust those first.
Health sharing plans
Health sharing plans such as Medi-Share operate differently from traditional insurance. They may require payment upfront, submission of a Good Faith Estimate, and a reimbursement request that you submit directly.
That structure is set by the sharing entity, not by us. Our team provides you with all the documentation your plan requires.
Our position
Care Decisions Are Not Financial Decisions
Clinical recommendations here are based on medical judgment and long-term outcomes, never on how a patient pays. The goal is to help you pursue medically appropriate care without financial toxicity, and to make sure every number is on the table before you commit to anything.
The care provided through Lotus Endometriosis Institute reflects a narrow high level of subspecialty surgical expertise, built on advanced training, cumulative experience, and the complexity of cases managed, that is not widely available within standard specialty practice or typical insurance networks. That is precisely why the financial structure is defined clearly and reviewed in advance.
